Monique Ryan (Kooyong, Independent) Share this | Hansard source

It was an honour to be part of the Standing Committee on Health, Aged Care and Sport's six-month-long investigation into long COVID. This significant work established a framework for a national response to this serious concern, but we still have much to do.

More than 90 per cent of Australians have now experienced COVID infection. Because most were immunised by the time that we got it and the most dominant strain during the biggest outbreaks was omicron, most of us were sick for no more than a few days, and we generally then recovered quickly with a sense of relief that it had been and gone.

But for many people COVID has not gone. The symptoms have persisted for more than three months, and those people have the disorder now known as long COVID. It has more than 200 symptoms. We heard many descriptions of individuals' difficult experiences of long COVID. We heard of persisting cough, shortness of breath, wild variation in heart rate, brain fog, anxiety, depression and fatigue. These are nightmare scenarios which last months, even years. Most people eventually recover, but some don't. Some can't work, exercise or function normally. The convalescent bear both the emotional and physical scars of their illnesses, but also the fear that those symptoms will recur with repeated infection. At least two per cent of people have persistent symptoms three months after COVID infection. Because numbers remain so high, at any point in time at least 200,000 people are affected by long COVID. It's more common after severe COVID, which more commonly affects the elderly and the frail and the unvaccinated, but because young people are getting more COVID, they're experiencing more long COVID as well.

We still don't have a case definition. We don't have a diagnostic test for long COVID. And that means that Australians who have been affected by it have had to negotiate a largely unknown condition with unproven treatment pathways, minimal supports and uncertain prognosis. Reporting strategies for COVID in this country have decayed. We don't know how much is in the community, and we're not doing much to eliminate its spread. We only know about the deaths from COVID—205 in the last week alone and more than 20,000 in total. We don't have any good epidemiological data on long COVID in Australia. We don't understand its impacts on our children, the elderly, the disabled, the immunocompromised and First Nations communities. Treatment options are patchy. Antivirals lessen the severity of acute COVID, and they probably decrease the risk of getting long COVID, but most of us can't access them.

The economic cost of long COVID is significant, quite apart from its emotional and social impact. It makes every sense to diagnose and treat it as quickly as possible, but early referral for rehabilitation is not possible if the services are not available. The committee found that best-practice treatment of long COVID demands both evidence based guidelines for primary care providers and escalation pathways to multidisciplinary specialist clinics with tele-rehabilitation services for rural and remote communities. But there are road blocks to care. There are GP shortages, lack of treatment guidelines, limited specialist hospital clinics and the sometimes Dickensian complexities of our Medicare system.

The only way to prevent long COVID is to prevent COVID. The risk of long COVID increases cumulatively with every infection. Many of us are now on our third or fourth infection. Vaccination decreases the severity and risk of long COVID, but vaccination uptake has almost stalled in Australia. The Albanese government has not advocated effectively on COVID vaccination. Only 51 per cent of elderly Australians have received their fifth dose, so most have waning immunity at this time. Young people have valid concerns about vaccine side-effects, and they have a perception of diminishing returns from repeated immunisation. Mask use in crowded indoor areas, testing and isolation decrease the transmission of the SARS-CoV-2 virus and the risk of long COVID, but public enthusiasm for all of those measures has waned, and our state and federal governments have effectively waved them away.

Almost all COVID infections occur indoors. We have not paid enough attention to the importance of clean air. Improving the air quality and ventilation of schools will prevent acute illnesses and it will prevent long COVID. This government needs to urgently review the National Construction Code and produce our first ever air quality guidelines for buildings. We have to improve our buildings and our schools to futureproof them against future respiratory illnesses.

The COVID committee heard again and again that we need better data collection. We have to understand who is getting COVID, how it's affecting them, how long it lasts, how best to treat it and what works and does not work.

We have heard that medical professionals are exhausted after a three-year pandemic. GPs are struggling with the workforce crisis, after years of stagnant income and increasing workload. Hospitals are struggling to staff outpatient clinics and to maintain inpatient services. Long COVID is a new, complex and severe medical condition, but we still don't know how common it is. We don't know how to diagnose it, treat it or track it. The impact of climate change and of increasing population movements are such that more pandemics are likely, so there's a really urgent need for us to learn the lessons of this one.

In preparing this report, the health committee listened to the unwell. We believed them, and we undertook to make their voices heard. This is not an easy task in a society which is increasingly fragmented and which is increasingly intolerant of difference. In undertaking the study, we consulted scientists, medical professionals and public health experts. Many have been, and continue to be, subjected to personal and professional abuse and invective at times during the pandemic and now in COVID's endemic phase. On receipt of this report, the federal health minister immediately promised $50 million from the Medical Research Future Fund for research to better inform policy decisions and to improve health outcomes for patients with long COVID. An expert advisory panel would delineate areas for future investment decisions, and that's important, but we don't yet have any clarity about the basis on which those decisions will be made and when that will be done. We need that detail, and we need it now. COVID is still with us. It is likely to be with us for years.

I note that funding for the National Clinical Evidence Taskforce—which was an invaluable alliance of 35 expert groups which coalesced quickly during the pandemic and acted effectively and efficiently together—expired at the end of last year. Its remaining philanthropic funding expires in 10 days. The NCET was a trove of evidence based scientific advice during the pandemic. Its evidence was cited 30 times in this committee's report. If it goes to pieces in 10 day, as it will if the government does not fund it, that group cannot easily be reassembled. It is ideally suited to development of evidence based living guidelines for the diagnosis and treatment of long COVID. One of the key recommendations of this report was development of those evidence based guidelines. The National Clinical Evidence Taskforce should immediately be given carryover funding pending the report of the MRFF panel.

With this report, the committee has delineated what needs to be done: planning and testing for treatment of further outbreaks; reviews of how our buildings are designed and built; and big picture considerations of how we can provide public health care in this country now and into the future. At some stage, we will have to re-evaluate the federal and state divides in the provision of health care in this country. We will have to re-evaluate the lack of big picture planning, how we fund medical research and in what circumstances we should ever again close the boundaries of our states and of our country. We'll have to examine our decision-making during the pandemic, our procurement and production of vaccines and equipment, quarantine and containment strategies, and workforce and economic management. I would suggest that this would best be achieved in the near future by a targeted, time limited royal commission into Australia's response to the COVID pandemic.

In the meantime, it's time for the Albanese government to demonstrate the vision and energy we need to tackle the very great challenge of long COVID. To that end, I commend this report to the House.

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